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'''Peter Denton White''' is a British psychiatrist and a prominent researcher in the field of [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS). White was an honorary consultant liaison psychiatrist at St Bartholomew's hospital and the co-lead of the East London chronic fatigue syndrome service until he retired from these positions in 2016.<ref name=":0">{{Cite web|url=https://www.qmul.ac.uk/wolfson/about-us/staff/profiles/whitedpeter.html| title = Peter D White, BSc, MBBS, MD, FRCP, FRCPsych - Wolfson Institute of Preventive Medicine - Barts and The London|website=qmul.ac.uk|access-date=2019-08-19}}</ref> His research in ME/CFS focused on Epstein Barr virus infection, the heterogeneity of the illness and the development of graded exercise therapy.<ref name="qmulstaff">{{Cite web|url=http://archive.wolfson.qmul.ac.uk/psychiatry/staff/white_pd.html| title = SMD > Wolfson Institute of Preventive Medicine > Psychiatry > Staff > Peter White|website=archive.wolfson.qmul.ac.uk|access-date=2019-08-19}}</ref> As lead author of the controversial PACE trial, White was criticized for misrepresenting the study’s findings in favor of cognitive behavioral therapy and graded exercise therapy.<ref name="Wilshire2018">{{Cite journal | last = Wilshire | first = Carolyn E. | last2 = Kindlon | first2 = Tom | last3 = Courtney | first3 = Robert | last4 = Matthees | first4 = Alem | last5 = Tuller | first5 = David | last6 = Geraghty | first6 = Keith | last7 = Levin | first7 = Bruce | date = 2018-03-22| title = Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT|url=https://www.ncbi.nlm.nih.gov/pubmed/29562932|journal=BMC psychology|volume=6|issue=1 | pages = 6|doi=10.1186/s40359-018-0218-3|issn=2050-7283|pmc=5863477|pmid=29562932}}</ref> [[File:Peter white.png|right]] == Biography == Peter Denton White qualified in medicine at St Bartholomew’s Hospital Medical College.<ref name=":1">{{Cite web|url=https://www.gov.uk/government/people/peter-white| title = Professor Peter White BSc, MBBS, MD, FRCP, FRCPsych, OBE - GOV.UK|website=gov.uk|language=en|access-date=2019-08-19}}</ref> He was trained in general medicine in Southampton and received his psychiatric training at the Maudsley and St Bartholomew’s Hospitals.<ref name=":1" /> He became Professor of Psychological Medicine at Barts and the London Medical School, Queen Mary University of London<ref name=":1" /> and was a consultant liaison psychiatrist and co-lead of the chronic fatigue syndrome service at St Bartholomew’s hospital, until he retired from these positions in 2016.<ref name=":0" /> White was one of the authors of the British diagnostic criteria for CFS, often referred to as the Oxford definition, and provided financial support for the guideline meeting.<ref name="SharpeArchard">{{Cite journal | last = Sharpe | first = M. C. | last2 = Archard | first2 = L.C. | last3 = Banatvala | first3 = J.E. | last4 = Borysiewicz | first4 = L.K. | last5 = Clare | first5 = A.W. | last6 = David | first6 = A. | last7 = Edwards | first7 = R.H. | last8 = Hawton | first8 = K.E. | last9 = Lambert | first9 = H.P. | date = Feb 1991| title = A report--chronic fatigue syndrome: guidelines for research|url=https://www.ncbi.nlm.nih.gov/pubmed/1999813|journal=Journal of the Royal Society of Medicine|volume=84|issue=2|pages=118–121|issn=0141-0768|pmc=1293107|pmid=1999813}}</ref> In 2002 White was one of the members of the Chief Medical Officer’s Working Group for ME/CFS, a position from which he resigned due to disagreements about the final report.<ref name=":25">{{Cite journal | last = Eaton | first = Lynn | date = 2002-01-05| title = Chronic fatigue report delayed as row breaks out over content|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121974/|journal=BMJ : British Medical Journal|volume=324|issue=7328 | pages = 7|issn=0959-8138|pmc=1121974|pmid=11777785}}</ref> White currently is a trustee of the Voluntary Hospital of St Bartholomew's and a member of the Independent Medical Experts Group, which advises the UK Ministry of Defence regarding its Armed Forces Compensation Scheme.<ref name=":2">{{Cite journal | last = White | first = Peter Denton | date = 2019-08-01| title = A perspective on causation of the chronic fatigue syndrome by considering its nosology|url=https://www.ncbi.nlm.nih.gov/pubmed/31373106|journal=Journal of Evaluation in Clinical Practice|doi=10.1111/jep.13240|issn=1365-2753|pmid=31373106}}</ref> He also provides paid consultancy to re‐ insurance companies.<ref name=":2" /> == Research == ===CFS following Epstein Barr Virus (EBV) Infection === In a large longitudinal study, White and colleagues followed up on 108 persons with Epstein Barr Virus (EBV-) infection, 83 patients with glandular not caused by EBV and 54 subjects with an ordinary upper respiratory tract infection (URTI).<ref name="WhiteThomas1998">{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Amess | first3 = J. | last4 = Crawford | first4 = D.H. | last5 = Grover | first5 = S.A. | last6 = Kangro | first6 = H.O. | last7 = Clare | first7 = A.W. | date = Dec 1998| title = Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/9926075|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=173 | pages = 475–481|doi=10.1192/bjp.173.6.475|issn=0007-1250|pmid=9926075}}</ref> These patients were followed up for more than six months to assess symptoms and disability. The results suggested that a distinct fatigue syndrome existed after glandular fever whose constituent symptoms were reliable over time.<ref name="WhiteThomas1995">{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Amess | first3 = J. | last4 = Grover | first4 = S.A. | last5 = Kangro | first5 = H.O. | last6 = Clare | first6 = A.W. | date = Sep 1995| title = The existence of a fatigue syndrome after glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/8588009|journal=Psychological Medicine|volume=25|issue=5 | pages = 907–916|issn=0033-2917|pmid=8588009}}</ref> The prevalence of CFS according to the Fukuda definition was 10%, six months after EBV-infection compared to 0% following an ordinary URTI.<ref name="WhiteThomas1998" /> No psychiatric disorder was significantly more prevalent six months following EBV-infection than before.<ref name="WhiteThomas1998" /> According to White et al. “The validity of the fatigue syndrome was supported, separate from psychiatric disorders in general and depressive disorders in particular.”<ref name="ClareAmess1995">{{Cite journal | last = Clare | first = A. W. | last2 = Amess | first2 = J. | last3 = Thomas | first3 = J.M. | last4 = Kangro | first4 = H.O. | last5 = Grover | first5 = S.A. | last6 = White | first6 = P. D. | date = Sep 1995| title = The validity and reliability of the fatigue syndrome that follows glandular fever |url =https://www.cambridge.org/core/journals/psychological-medicine/article/validity-and-reliability-of-the-fatigue-syndrome-that-follows-glandular-fever/E86878CFD22D70A59CF4E6AA1802885E|journal=Psychological Medicine|language=en|volume=25|issue=5 | pages = 917–924|doi=10.1017/S0033291700037405|issn=1469-8978}}</ref> Using data from the General Practice Research Database (GPRD), White and colleagues reported that significantly more fatigue symptoms were reported in the months following EBV-infection compared to tonsillitis and influenza.<ref>{{Cite journal | last = Petersen | first = I. | last2 = Thomas | first2 = J.M. | last3 = Hamilton | first3 = W.T. | last4 = White | first4 = P. D. | date = Jan 2006| title = Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort|url=https://www.ncbi.nlm.nih.gov/pubmed/16330509|journal=QJM: monthly journal of the Association of Physicians|volume=99|issue=1 | pages = 49–55|doi=10.1093/qjmed/hci149|issn=1460-2725|pmid=16330509}}</ref> White is also a member of The International Collaborative on Fatigue Following Infection (COFFI)<ref>{{Cite journal | last = Katz | first = Ben Z | author-link = Ben Katz | last2 = Collin | first2 = Simon M | authorlink2 = Simon Collin | last3 = Murphy | first3 = Gabrielle | author-link3 = Gabrielle Murphy | last4 = Moss-Morris | first4 = Rona | author-link4 = Rona Moss-Morris | last5 = Wyller | first5 = Vegard Bruun | author-link5 = Vegard Bruun Wyller | last6 = Wensaas | first6 = Knut-Arne | last7 = Hautvast | first7 = Jeannine L.A. | last8 = Bleeker-Rovers | first8 = Chantal P | last9 = Vollmer-Conna | first9 = Ute | authorlink9 = Uté Vollmer-Conna | date = 2018 | title=The International Collaborative on Fatigue Following Infection (COFFI)|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333416/|journal=Fatigue: biomedicine, health & behavior|volume=6|issue=2|pages=106–121|doi=10.1080/21641846.2018.1426086|issn=2164-1846|pmc=6333416|pmid=30666281|quote=}}</ref> which has been established to study post-infection fatigue and related symptoms by sharing data and samples from cohorts around the world.<ref>{{Cite web|url=https://internationalcoffi.wordpress.com/| title = COFFI|website=COFFI|language=en|access-date=2019-08-19}}</ref> ===Graded exercise therapy (GET) === Peter White helped develop graded exercise therapy (GET) <ref name=":4">{{Cite journal | last = Fulcher | first = K. Y. | last2 = White | first2 = P. D. | date = 1997-06-07| title = Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/9180065|journal=BMJ (Clinical research ed.)|volume=314|issue=7095|pages=1647–1652|doi=10.1136/bmj.314.7095.1647|issn=0959-8138|pmc=2126868|pmid=9180065}}</ref><ref name=":5">{{Cite journal | last = Clark | first = Lucy V. | last2 = White | first2 = Peter D. | date = 2005-06-01| title = The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS)|url=https://doi.org/10.1080/09638230500136308|journal=Journal of Mental Health|volume=14|issue=3|pages=237–252|doi=10.1080/09638230500136308|issn=0963-8237}}</ref>, on the basis that "CFS maintained by both the avoidance of activity and deconditioning."<ref name=":11">{{Cite journal | last = Gallagher | first = A.M. | last2 = Coldrick | first2 = A.R. | last3 = Hedge | first3 = B. | last4 = Weir | first4 = W.R.C. | last5 = White | first5 = P. D. | date = Apr 2005| title = Is the chronic fatigue syndrome an exercise phobia? A case control study|url=https://www.ncbi.nlm.nih.gov/pubmed/15992572|journal=Journal of Psychosomatic Research|volume=58|issue=4|pages=367–373|doi=10.1016/j.jpsychores.2005.02.002|issn=0022-3999|pmid=15992572}}</ref> In of his studies CFS patients were compared to sedentary controls. While both were equally unfit, CFS patients had reduced exercise capacity and perceived greater effort during exercise than sedentary controls.<ref>{{Cite journal | last = Fulcher | first = K. Y. | last2 = White | first2 = P. D. | date = Sep 2000| title = Strength and physiological response to exercise in patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10945803|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=69|issue=3|pages=302–307|doi=10.1136/jnnp.69.3.302|issn=0022-3050|pmc=1737090|pmid=10945803}}</ref> With GET patients are instructed to gradually increase their level of physical activity.<ref name=":4" /> Under the guidance of a trained physical therapist, patients are instructed to find a baseline of physical activity they can easily manage, even on bad days.<ref name=":5" /> From there, the amount of exercise is increased time-contingently with the goal of reaching 30 minutes five times a week. When patients reach their goals, the intensity of exercise can be increased for example by going from walking to running or swimming.<ref>Bavinton J, Darbishire L, White PD. PACE. [https://me-pedia.org/images/8/89/PACE-get-therapist-manual.pdf Manual For Therapists. Graded Exercise Therapy. MREC Version 2]. 16 November 2004. </ref> According to White, patients can improve and even recover from CFS by following GET.<ref>{{Cite journal | last = White | first = P. D. | last2 = Goldsmith | first2 = K. | last3 = Johnson | first3 = A.L. | last4 = Chalder | first4 = T. | last5 = Sharpe | first5 = M. | date = Oct 2013| title = Recovery from chronic fatigue syndrome after treatments given in the PACE trial|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776285/|journal=Psychological Medicine|volume=43|issue=10|pages=2227–2235|doi=10.1017/S0033291713000020|issn=0033-2917|pmc=3776285|pmid=23363640}}</ref> He has argued that “patients can be released from their self-perpetuating cycle of inactivity if the impairments that occur due to inactivity and their physiological deconditioning can be reversed. This can occur if they are willing to gradually exceed their perceived energy limits, and recondition their bodies through GET.”<ref name=":5" /> White has conducted three randomized trials that assessed the effectiveness of GET.<ref name=":4" /><ref name=":19">{{Cite journal | last = Sharpe | first = M. | last2 = Chalder | first2 = T. | last3 = McCrone | first3 = P. | last4 = Wilks | first4 = D. | last5 = O'Dowd | first5 = H. | last6 = Murphy | first6 = M. | last7 = Murphy | first7 = G. | last8 = Angus | first8 = B.J. | last9 = Bavinton | first9 = J. | date = 2011-03-05| title = Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract|journal=The Lancet|language=English|volume=377|issue=9768 | pages = 823–836|doi=10.1016/S0140-6736(11)60096-2|issn=0140-6736|pmid=21334061}}</ref><ref>{{Cite journal | last = White | first = Peter D. | last2 = Beynon | first2 = Michelle | last3 = Vergara-Williamson | first3 = Mario | last4 = Thomas | first4 = Janice M. | last5 = Pesola | first5 = Francesca | last6 = Clark | first6 = Lucy V. | date = 2017-07-22| title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32589-2/abstract|journal=The Lancet|language=English|volume=390|issue=10092|pages=363–373|doi=10.1016/S0140-6736(16)32589-2|issn=0140-6736|pmid=28648402}}</ref> All claimed that CFS patients significantly improved in the GET-group, although the results have been challenged by others.<ref>{{Cite journal | last = Shepherd | first = C. | last2 = Macintyre | first2 = A. | date = 1997-10-11| title = Graded exercise in chronic fatigue syndrome. Patients should have initial period of rest before gradual increase in activity|url=https://www.ncbi.nlm.nih.gov/pubmed/9361549|journal=BMJ (Clinical research ed.)|volume=315|issue=7113 | pages = 947; author reply 948|issn=0959-8138|pmc=2127628|pmid=9361549}}</ref><ref>{{Cite journal | last = Franklin | first = A.J. | date = 1997-10-11| title = Graded exercise in chronic fatigue syndrome. Including patients who rated themselves as a little better would have altered results|url=https://www.ncbi.nlm.nih.gov/pubmed/9361550|journal=BMJ (Clinical research ed.)|volume=315|issue=7113 | pages = 947; author reply 948|issn=0959-8138|pmc=2127632|pmid=9361550}}</ref><ref>{{Cite journal | last = Wood | first = Anna | date = Mar 24, 2018| title = Graded exercise self-help for chronic fatigue syndrome in GETSET|url=https://www.ncbi.nlm.nih.gov/pubmed/29595493|journal=Lancet (London, England)|volume=391|issue=10126|pages=1161–1162|doi=10.1016/S0140-6736(18)30619-6|issn=1474-547X|pmid=29595493}}</ref><ref>{{Cite journal | last = Crawford | first = Joan S. | date = Mar 24, 2018| title = Graded exercise self-help for chronic fatigue syndrome in GETSET|url=https://www.ncbi.nlm.nih.gov/pubmed/29595492|journal=Lancet (London, England)|volume=391|issue=10126|pages=1160|doi=10.1016/S0140-6736(18)30621-4|issn=1474-547X|pmid=29595492}}</ref> A review by Vink & Vink-Niese indicated that patients rarely improve on objective outcomes following GET.<ref>{{Cite journal | last = Vink | first = Mark | last2 = Vink-Niese | first2 = Alexandra | date = Jul 2018| title = Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review|url=https://www.ncbi.nlm.nih.gov/pubmed/30305916|journal=Health Psychology Open|volume=5|issue=2|pages=2055102918805187|doi=10.1177/2055102918805187|issn=2055-1029|pmc=6176540|pmid=30305916}}</ref> White has acknowledged that “GET does not work by improving physical fitness”<ref name=":6">{{Cite journal | last = Cheshire | first = Anna | last2 = Ridge | first2 = Damien | last3 = Clark | first3 = Lucy | last4 = White | first4 = Peter | date = 2018-10-16| title = Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions|url=https://www.ncbi.nlm.nih.gov/pubmed/30325677|journal=Disability and Rehabilitation|pages=1–10|doi=10.1080/09638288.2018.1499822|issn=1464-5165|pmid=30325677}}</ref> but argued that it may work by improving exercise tolerance or reducing fear avoidance.<ref name=":6" /> The use of GET has been controversial in the ME/CFS community. In several surveys, patients indicated to have been harmed by this treatment.<ref>Kindlon, T. [https://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.] ''Bulletin of the IACFS/ME''. 2011;19(2):59-111.</ref> White has said that reports of harm are merely examples of GET being wrongly applied, for example when patients are told to go to the gym to exercise without any guidance<ref>{{Cite journal | last = Clark | first = Lucy V. | last2 = White | first2 = Peter D. | date = Nov 2008| title = Chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/19242631|journal=Journal of Rehabilitation Medicine|volume=40|issue=10 | pages = 882–883; author reply 883–885|doi=10.2340/16501977-0261|issn=1651-2081|pmid=19242631}}</ref> - an explanation that has been contested.<ref>{{Cite journal | last = Kirke | first = Karen D. | date = Aug 2017| title = PACE investigators' response is misleading regarding patient survey results|url=https://www.ncbi.nlm.nih.gov/pubmed/28805528|journal=Journal of Health Psychology|volume=22|issue=9|pages=1168–1176|doi=10.1177/1359105317703787|issn=1461-7277|pmid=28805528}}</ref> White has acknowledged however that “It is an apparent paradox that graded exercise programmes are prescribed for patients with CFS/ME, when post-exertional malaise is a feature, which requires explanation.”<ref name=":6" /> === Risk factors and prognosis of CFS === Using data from the 1958 British birth cohort White was able to study premorbid risk factors for (self-reported) CFS/ME. The study could not confirm a connection with activity levels in child- or adulthood. Female gender, premorbid psychopathology, childhood gastrointestinal symptoms and parental reports of many colds increased the risk of self-reported CFS/ME in later life.<ref>{{Cite journal | last = White | first = Peter D. | last2 = Hotopf | first2 = Matthew | last3 = Stansfeld | first3 = Stephen A. | last4 = Goodwin | first4 = Laura | last5 = Clark | first5 = Charlotte | date = Oct 2011| title = Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort|url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/premorbid-risk-markers-for-chronic-fatigue-syndrome-in-the-1958-british-birth-cohort/13FD27D7ABC50DB975C43717CF465CCF|journal=The British Journal of Psychiatry|language=en|volume=199|issue=4|pages=323–329|doi=10.1192/bjp.bp.110.083956|issn=0007-1250}}</ref> There was also an association with parental physical abuse, although this factor was assessed retrospectively.<ref>{{Cite web|url=https://forums.phoenixrising.me/threads/premorbid-risk-markers-for-chronic-fatigue-syndrome-in-the-1958-british-birth-cohort.13090/| title = Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort | website = Phoenix Rising ME / CFS Forums|language=en-US|access-date=2019-08-19}}</ref> Using data from the General Practice Research Database (GPRD), White and colleagues were able to report that viral infections were a risk marker for CFS, while gastroenteritis put persons at greater risk for irritable bowel syndrome.<ref>{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Gallagher | first3 = A.M. | last4 = Hamilton | first4 = W.T. | date = Nov 2009| title = Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study in primary care|url=https://www.cambridge.org/core/journals/psychological-medicine/article/risk-markers-for-both-chronic-fatigue-and-irritable-bowel-syndromes-a-prospective-casecontrol-study-in-primary-care/FCD39EEB36A3FA20D1FD28D720F779A2|journal=Psychological Medicine|language=en|volume=39|issue=11|pages=1913–1921|doi=10.1017/S0033291709005601|issn=1469-8978}}</ref> Using the GPRD, White estimated the incidence of CFS to be 14.8 per 100,000 people.<ref name=":7">{{Cite journal | last = Collin | first = Simon M. | last2 = Bakken | first2 = Inger J. | last3 = Nazareth | first3 = Irwin | last4 = Crawley | first4 = Esther | last5 = White | first5 = Peter D. | date = Jun 2017| title = Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001-2013: a Clinical Practice Research Datalink study|url=https://www.ncbi.nlm.nih.gov/pubmed/28358988|journal=Journal of the Royal Society of Medicine|volume=110|issue=6|pages=231–244|doi=10.1177/0141076817702530|issn=1758-1095|pmc=5499564|pmid=28358988}}</ref> The data indicated that the incidence of CFS had remained relatively constant during the period 2001-2013, even decreasing a little over time.<ref name=":7" /> White and colleagues also reported that CFS-patients had a 50% increased GP consultation rate in the 10 years before their CFS diagnosis in the GPRD, compared to controls.<ref name=":8">{{Cite journal | last = Collin | first = Simon M. | last2 = Bakken | first2 = Inger J. | last3 = Nazareth | first3 = Irwin | last4 = Crawley | first4 = Esther | last5 = White | first5 = Peter D. | date = 2017-05-05| title = Health care resource use by patients before and after a diagnosis of chronic fatigue syndrome (CFS/ME): a clinical practice research datalink study|url=https://doi.org/10.1186/s12875-017-0635-z|journal=BMC Family Practice|volume=18|issue=1 | pages = 60|doi=10.1186/s12875-017-0635-z|issn=1471-2296|pmc=5420108|pmid=28476151}}</ref> Healthcare consumption peaked in the year of CFS/ME diagnosis but quickly reached levels similar to the period before diagnosis.<ref name=":8" /> === Activated cytokines === In one of his first papers featuring CFS, White speculated that the condition may be the result of activated cytokines such as Interleukin 1.<ref>{{Cite journal | last = Ur | first = E. | last2 = White | first2 = P. D. | last3 = Grossman | first3 = A. | date = 1992| title = Hypothesis: cytokines may be activated to cause depressive illness and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/1606197|journal=European Archives of Psychiatry and Clinical Neuroscience|volume=241|issue=5|pages=317–322|issn=0940-1334|pmid=1606197}}</ref> He subsequently tested the activation of cytokines in CFS patients before and after performing an exercise test.<ref>{{Cite journal | last = White | first = P. D. | last2 = Nye | first2 = K.E. | last3 = Pinching | first3 = A.J. | last4 = Yap | first4 = T.M. | last5 = Power | first5 = N. | last6 = Vleck | first6 = V. | last7 = Bentley | first7 = D.J. | last8 = Thomas | first8 = J.M. | last9 = Buckland | first9 = M. | date = 2004-01-01| title = Immunological Changes After Both Exercise and Activity in Chronic Fatigue Syndrome|url=https://doi.org/10.1300/J092v12n02_06|journal=Journal of Chronic Fatigue Syndrome|volume=12|issue=2 | pages = 51–66|doi=10.1300/J092v12n02_06|issn=1057-3321}}</ref> In a 2015 review, however, White and colleagues reported that studies on cytokines in CFS are often of poor quality and have conflicting results.<ref name=":9">{{Cite journal | last = Blundell | first = S. | last2 = Ray | first2 = K.K. | last3 = Buckland | first3 = M. | last4 = White | first4 = P. D. | date = Nov 2015 | title = Chronic fatigue syndrome and circulating cytokines: A systematic review|url=https://www.ncbi.nlm.nih.gov/pubmed/26148446|journal=Brain, Behavior, and Immunity|volume=50|pages=186–195|doi=10.1016/j.bbi.2015.07.004|issn=1090-2139|pmid=26148446}}</ref> According to the authors, the only consistent finding has been an increase in transforming growth factor-beta (TGF-β).<ref name=":9" /> A subsequent study by White’s research group showed that TGF-β was the only cytokine significantly increased in CFS patients compared to controls, but that this was considered “a spurious finding due to variation between different assay batches.”<ref name=":10">{{Cite journal | last = Clark | first = L.V. | last2 = Buckland | first2 = M. | last3 = Murphy | first3 = G. | last4 = Taylor | first4 = N. | last5 = Vleck | first5 = V. | last6 = Mein | first6 = C. | last7 = Wozniak | first7 = E. | last8 = Smuk | first8 = M. | last9 = White | first9 = P. D. | date = Dec 2017| title = Cytokine responses to exercise and activity in patients with chronic fatigue syndrome: case-control study|url=https://www.ncbi.nlm.nih.gov/pubmed/28779554|journal=Clinical and Experimental Immunology|volume=190|issue=3|pages=360–371|doi=10.1111/cei.13023|issn=1365-2249|pmc=5680051|pmid=28779554}}</ref> According to the authors, the results suggest that “elevated circulating cytokines are not important in the pathophysiology of CFS” although a role for local release of cytokines in the central nervous system (CNS) was not ruled out.<ref name=":10" /> === Subgrouping: to both 'lump' and 'split' === White has argued that CFS is a heterogeneous label representing more than one separate condition and that this might explain the lack of replication in the field. “If CFS is found to be more than one separate condition", he wrote, “this could explain why no replicated causes have been found associated with the illness, since an association found only in one subgroup would be diluted, and risk being found non‐significant, by mixing the subgroup with others.”<ref name=":12">{{Cite journal | last = White | first = Peter Denton | date = 2019-08-01| title = A perspective on causation of the chronic fatigue syndrome by considering its nosology|url=https://www.ncbi.nlm.nih.gov/pubmed/31373106|journal=Journal of Evaluation in Clinical Practice|doi=10.1111/jep.13240|issn=1365-2753|pmid=31373106}}</ref> White was able to perform subgroup analysis on the data collected during two large epidemiological studies by the Centers for Disease Control and Prevention in the United States. Principal components analysis was conducted on selected CFS patients, patients with idiopathic chronic fatigue and healthy controls from the Wichita, Kansas study.<ref name=":13">{{Cite journal | last = Vollmer-Conna | first = Uté | last2 = Aslakson | first2 = Eric | last3 = White | first3 = Peter D. | date = Apr 2006| title = An empirical delineation of the heterogeneity of chronic unexplained fatigue in women|url=https://www.ncbi.nlm.nih.gov/pubmed/16610946|journal=Pharmacogenomics|volume=7|issue=3|pages=355–364|doi=10.2217/14622416.7.3.355|issn=1462-2416|pmid=16610946}}</ref> The analysis indicated 6 different classes which were mostly based on factors such as obesity, depression, and apnea.<ref name=":13" /><ref>{{Cite journal | last = Aslakson | first = Eric | last2 = Vollmer-Conna | first2 = Uté | last3 = White | first3 = Peter D | date = 2006-04-01| title = The validity of an empirical delineation of heterogeneity in chronic unexplained fatigue|url=https://www.futuremedicine.com/doi/abs/10.2217/14622416.7.3.365|journal=Pharmacogenomics|volume=7|issue=3|pages=365–373|doi=10.2217/14622416.7.3.365|issn=1462-2416}}</ref> Similar groups were found in the analysis of data from the CDC’s prevalence study in Georgia.<ref name=":14">{{Cite journal | last = Aslakson | first = Eric | last2 = Vollmer-Conna | first2 = Uté | last3 = Reeves | first3 = William C. | last4 = White | first4 = Peter D. | date = 2009-10-05| title = Replication of an empirical approach to delineate the heterogeneity of chronic unexplained fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/19804639|journal=Population Health Metrics|volume=7|pages=17|doi=10.1186/1478-7954-7-17|issn=1478-7954|pmc=2761845|pmid=19804639}}</ref> According to the authors, this replication supported “the broadening of the concept of CFS to include patients with fewer symptoms but similar disability.”<ref name=":14" /> White has recommended that NICE guidelines for the diagnosis of CFS as the most useful as it requires only one additional symptom beyond post‐exertional fatigue.<ref name=":12" /><ref name=":26">[https://www.youtube.com/watch?v=doY1WK1plOQ Psychiatrist Peter White at the Royal Society of Medicine 2008 - Defining CFS/ME.]</ref> White has however been critical of proposals to lump several functional somatic syndromes (FSS) - which in his view includes ME/CFS - into one diagnostic entity.<ref name=":15">{{Cite journal | last = Wessely | first = Simon | last2 = White | first2 = Peter D. | date = Aug 2004| title = There is only one functional somatic syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/15286058|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=185 | pages = 95–96|doi=10.1192/bjp.185.2.95|issn=0007-1250|pmid=15286058}}</ref><ref name=":16">{{Cite journal | last = White | first = Peter D. | date = May 2010| title = Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the "one vs. many" functional somatic syndromes debate|url=https://www.ncbi.nlm.nih.gov/pubmed/20403504|journal=Journal of Psychosomatic Research|volume=68|issue=5 | pages = 455–459|doi=10.1016/j.jpsychores.2010.01.008|issn=1879-1360|pmid=20403504}}</ref><ref>{{Cite journal | last = White | first = Peter D. | date = Jan 2013| title = Functional somatic syndromes may be either "polysyndromic" or "monosyndromic"|url=https://www.ncbi.nlm.nih.gov/pubmed/23272980|journal=Journal of Psychosomatic Research|volume=74|issue=1|pages=2–3|doi=10.1016/j.jpsychores.2012.10.005|issn=1879-1360|pmid=23272980}}</ref> He has argued that there is little overlap between conditions such as fibromyalgia and irritable bowel syndrome, that treatments and risk factors between FSS may differ and that “historically, more progress has been made through splitting illnesses rather than lumping them together.”<ref name=":15" /> According to White “A general functional somatic syndrome can be consistent only with psychogenesis, since it is difficult to conceive of a pathophysiological mechanism that would be common to all functional somatic syndromes.”<ref name=":15" /> As an alternative White proposes to be “over‐inclusive regarding the diagnosis as a first step, while subdividing the condition into likely subgroups as a means of finding valid and reliable associations with potential causes”<ref name=":12" /> He has argued that "the solution to the debate is that we need to both 'lump' and 'split.' We need to study both the similarities between syndromes and their dissimilarities to better understand what we currently call the FSSs."<ref name=":16" /> === Central Sensitization === While White has originally emphasized the role of deconditioning in the pathology of CFS, in recent years he has highlighted the potential role of central sensitization, a suspected hypersensitivity of the central nervous system.<ref name=":17">{{Cite journal | last = Bourke | first = Julius H. | last2 = Langford | first2 = Richard M. | last3 = White | first3 = Peter D. | date = Mar 2015 | title = The common link between functional somatic syndromes may be central sensitisation|url=https://www.ncbi.nlm.nih.gov/pubmed/25598410|journal=Journal of Psychosomatic Research|volume=78|issue=3|pages=228–236|doi=10.1016/j.jpsychores.2015.01.003|issn=1879-1360|pmid=25598410}}</ref> He has argued that central sensitization may form a common link between functional somatic syndromes, whereas precipitating events such as environmental exposures could mark the development of specific syndromes or their sub-phenotypes.<ref name=":17" /> White has also emphasized the role of interoception<ref>{{Cite journal | last = Smith | first = Wayne R | last2 = White | first2 = Peter D | last3 = Buchwald | first3 = Dedra | date = 2006-11-13| title = A case control study of premorbid and currently reported physical activity levels in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1647270/|journal=BMC Psychiatry|volume=6 | pages = 53|doi=10.1186/1471-244X-6-53|issn=1471-244X|pmc=1647270|pmid=17101056}}</ref> and abnormal perception of effort in CFS.<ref name=":5" /> His research however indicated that CFS patients do no have an exercise phobia.<ref name=":11" /> == Controversies == === The PACE trial === Peter White was the lead investigator of the PACE trial, a 5 million pound study that investigated the effectiveness of cognitive behavioral therapy (CBT), graded exercise therapy (GET) and adaptive pacing therapy (APT) in a sample of more than 600 CFS patients.<ref name=":19" /> While the reported findings indicated that CBT and GET were effective treatments for CFS, the authors have been criticized for misrepresenting the trials’ results.<ref name="Wilshire2018" /><ref name="Tuller20151021">{{Cite web|url=http://www.virology.ws/2015/10/21/trial-by-error-i/| title = TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study|website=[[Virology blog]]|access-date=2019-08-19}}</ref><ref name=":21">{{Cite journal | last = Geraghty | first = Keith J. | date = Aug 2017| title = 'PACE-Gate': When clinical trial evidence meets open data access|url=https://www.ncbi.nlm.nih.gov/pubmed/27807258|journal=Journal of Health Psychology|volume=22|issue=9|pages=1106–1112|doi=10.1177/1359105316675213|issn=1461-7277|pmid=27807258}}</ref><ref name="Williams2016PW" /> The PACE authors deviated from the methods specified in their protocol, without explaining these changes in full in their publications or how the changes impacted the reported findings.<ref name="Tuller20151021" /><ref name=":21" /> Following inconsistencies in the economic analysis of the PACE trial, health psychologist James Coyne filed a request to the journal PLOS ONE to access the data of the trial, a request that was dismissed as vexatious by Kings College London.<ref>{{Cite web|url=https://web.archive.org/web/20160314024024/https://dl.dropboxusercontent.com/u/23608059/PACE%20F325-15%20-%20Prof.%20James%20Coyne%20-%20Response-2.pdf| title = Request for information under the Freedom of Information Act 2000 ("the Act") | date = 2016-03-14 | website = web.archive.org|access-date=2019-08-19}}</ref> PLOS ONE has since issued an expression of concern about the publication in question.<ref>{{Cite journal | last = White | first = Peter D. | last2 = Goldsmith | first2 = Kimberley A. | last3 = Johnson | first3 = Anthony L. | last4 = Knapp | first4 = Martin | last5 = Chalder | first5 = Trudie | last6 = Sharpe | first6 = Michael | last7 = McCrone | first7 = Paul | date = 2012-08-01| title = Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0040808|journal=PLOS ONE|language=en|volume=7|issue=8| pages = e40808|doi=10.1371/journal.pone.0040808|issn=1932-6203|pmc=3411573|pmid=22870204}}</ref> The PACE authors have refused to share the trial's data for independent reanalysis due to concerns that “patients might be personally identified by releasing their data.”<ref name=":22">{{Cite journal | last = White | first = Peter D | last2 = Chalder | first2 = Trudie | last3 = Sharpe | first3 = Michael | last4 = Angus | first4 = Brian J | last5 = Baber | first5 = Hannah L | last6 = Bavinton | first6 = Jessica | last7 = Burgess | first7 = Mary | last8 = Clark | first8 = Lucy V | last9 = Cox | first9 = Diane L | date = 2017-01-24| title = Response to the editorial by Dr Geraghty|url=https://journals.sagepub.com/doi/10.1177/1359105316688953|journal=Journal of Health Psychology|language=en-US|volume=22|issue=9|pages=1113–1117|doi=10.1177/1359105316688953|issn=1359-1053}}</ref> Peter White has also criticized the "All Trials campaign" as it encourages authors to share their datasets publicly.<ref>{{Cite journal | last = White | first = Peter D. | date = 2013-05-28| title = Is sharing data from clinical trials always a good idea?|url=https://www.bmj.com/content/346/bmj.f3379|journal=BMJ|language=en|volume=346|pages=f3379|doi=10.1136/bmj.f3379|issn=1756-1833|pmid=23714258}}</ref> During a 2015 first tribunal hearing on the release of the PACE trial data, Professor Ross Anderson defended the PACE authors’ decision by making “wild speculations” about “young men, borderline sociopathic or psychopathic” being attached to criticism of the PACE trial.<ref name=":23">{{Cite web|url=https://www.meaction.net/2016/08/16/tribunal-orders-release-of-pace-data/| title = Tribunal orders release of PACE data | date = 2016-08-16 | website = #MEAction|language=en-US|access-date=2019-08-19}}</ref> The tribunal considered these claims to be unfounded and ordered the release of some of the anonymized data of the trial.<ref name=":23" /> An independent reanalysis showed that the PACE authors had inflated improvement and recovery rates threefold.<ref name="Wilshire2018" /> An open letter signed by more than 100 prominent ME/CFS experts including researchers, clinicians, and MPs has called for “an independent re-analysis of the individual-level trial data, with appropriate sensitivity analyses.<ref>{{Cite web|url=http://www.virology.ws/2018/08/13/trial-by-error-open-letter-to-the-lancet-version-3-0/| title = Trial By Error: Open Letter to The Lancet, version 3.0 | website = [[Virology blog]]|language=en-US|access-date=2019-08-19}}</ref> In a letter to Richard Horton, editor of the Lancet journal, Peter White et al stated: “The PACE trial paper refers to chronic fatigue syndrome (CFS) which is operationally defined; it does not purport to be studying CFS/ME”;<ref>{{Cite web|url=https://www.nice.org.uk/guidance/cg53/evidence/appendix-c-stakeholder-consultation-comments-table-pdf-4602203536| title = CG53 Evidence - Appendix C: Stakeholder Comments | last = NICE | first = | authorlink = National Institute for Health and Care Excellence | date = | website = | page = 43|archive-url=|archive-date=|access-date=Aug 22, 2019}}</ref> however the authors separately stated their results had also been validated against a modified version of the [[London criteria|London criteria for ME]]. According to White et al. criticism of the PACE trial is based on “misunderstandings and misrepresentations”<ref name=":22" />. In 2016 article in the Guardian newspaper, White wrote that "If my team’s research on ME is rejected, the patients will suffer.”<ref>{{Cite news | url=https://www.theguardian.com/commentisfree/2016/sep/30/me-chronic-fatigue-syndrome-patients-suffer-put-off-treatments-our-research| title = If my team’s research on ME is rejected, the patients will suffer {{!}} Peter White | last = White | first = Peter | date = 2016-09-30|work=The Guardian|access-date=2019-08-19|language=en-GB|issn=0261-3077}}</ref> === An adverse effect of the label ME === In one of their studies using the GPRD, White and colleagues reported that the prognosis of patients diagnosed with ME was worse than those diagnosed with CFS or post-viral fatigue syndrome.<ref name=":24">{{Cite journal | last = White | first = Peter D. | last2 = Thomas | first2 = Janice M. | last3 = Gallagher | first3 = Arlene M. | last4 = Hamilton | first4 = William T. | date = 2005-08-01| title = The prognosis of different fatigue diagnostic labels: a longitudinal survey|url=https://academic.oup.com/fampra/article/22/4/383/662673|journal=Family Practice|language=en|volume=22|issue=4|pages=383–388|doi=10.1093/fampra/cmi021|issn=0263-2136}}</ref> The authors considered it unlikely that there was a difference in the underlying condition which the GP’s could accurately differentiate. They speculated that the poorer prognosis of ME was due to the label itself. “It is possible”, the authors wrote, “that the label ME with its suggestion of an untreatable pathological process may somehow render the patient less able to combat their symptoms and disability than other labels.”<ref name=":24" /> === Resigning from the CMO working group === White was one of the members of the Chief Medical Officer’s (CMO) Working Group for ME/CFS, a position from which he resigned due to disagreements about the final report.<ref name=":25" /><ref name="Williams2016PW" /> White and other members who resigned found that the report played down the psychological and social aspects of the condition and concentrates on a medical model.<ref name=":25" /> In an Editorial, White explained that criticism of the report included the “dangers of both over-medicalisation of chronic fatigue and the iatrogenic damage consequent upon that.”<ref name=":27">{{Cite journal | last = White | first = P. D. | date = Aug 2002| title = Chronic unexplained fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/12185213|journal=Postgraduate Medical Journal|volume=78|issue=922 | pages = 445–446|doi=10.1136/pmj.78.922.445|issn=0032-5473|pmc=1742445|pmid=12185213}}</ref> White also disagreed with the inclusion of pacing as a recommended treatment advice, writing that “the theoretical risk of pacing is that the patient remains trapped by their symptoms in the envelope of ill health.”<ref name=":27" /> === Comments on 2007 NICE guideline === During the development of the 2007 guidelines form the National Institute for Health and Care Excellence (NICE), several controversial comments were made to the draft version of the report, by St Bartholomew’s Hospital Chronic Fatigue Services, which at the time was headed by Peter White.<ref name=":28">{{Cite web|url=https://meagenda.wordpress.com/2007/09/06/a-selection-of-points-the-barts-cf-service-made-during-the-nice-guidelines-for-cfs-me-tom-kindlon/| title = A Selection of points the Barts CF Service made during the NICE Guidelines for CFS / ME: Tom Kindlon | last = meagenda | date = 2007-09-06 | website = ME agenda|language=en|access-date=2019-08-19}}</ref> The comments criticized the provision of equipment and adaptations (for example, a wheelchair,blue badge or stairlift) to allow individuals to improve their independence. St Bartholomew’s provided the following feedback: <blockquote>“Where is the warning about dependence being encouraged and expectation of recovery being damaged by the message that is given in this intervention? We are in no doubt that it is a powerful message for a therapist of any sort to provide such aids. Our view is that such aids should only be considered by a multi-disciplinary therapeutic team as a whole, and usually in the context of providing a temporary means for a patient to increase their activity levels.”<ref name=":28" /> </blockquote>Regarding multiple chemical sensitivites (MCS), Bartholomew’s commented that “MCS is a potentially remediable condition through a graded exposure programme on the basis that the underlying pathophysiology is a conditioned response. It should not be considered as a part of CFS/ME.”<ref name=":28" /> === WHO classification === White has repeatedly stated that there are multiple ways of classifying CFS using the World Health Organization's (WHO) International Classification of Diseases, version 10 ([[ICD-10]]).<ref name=":2" /><ref name=":29">{{Cite journal | last = White | first = P. D. | last2 = Rickards | first2 = H. | last3 = Zeman | first3 = A. Z.J. | date = 2012-05-24| title = Time to end the distinction between mental and neurological illnesses|url=https://www.ncbi.nlm.nih.gov/pubmed/22628005|journal=BMJ (Clinical research ed.)|volume=344| pages = e3454|doi=10.1136/bmj.e3454|issn=1756-1833|pmid=22628005}}</ref><ref name=":26" /> He has claimed for example that “chronic fatigue syndrome may be classified as myalgic encephalomyelitis (ME) within the neurology chapter (G93.3) of ICD-10, or as neurasthenia, a psychiatric disorder (F 48.0).”<ref name=":29" /> The WHO however classifies ME, CFS and post-viral fatigue syndrome (PVFS) under code G93.3 in Chapter VI Diseases of the nervous system of ICD-10, and has made clear that it “is not permitted for the same condition to be classified to more than one rubric”.<ref>{{Cite web|url=https://dxrevisionwatch.com/icd-11-me-cfs/| title = ICD-10: ME, CFS | date = 2009-12-26 | website = dx revision watch|language=en|access-date=2019-08-19}}</ref> ICD-10 explicitly excludes code G93.3 (PVFS, ME and CFS) from the neurasthenia diagnosis F48.0.<ref>{{Cite web|url=https://icd.who.int/browse10/2010/en#/F48.0| title = ICD-10 Version:2010 | website = icd.who.int|access-date=2019-08-19}}</ref> White has also stated incorrectly that CFS can be classified under "R53.82 Chronic fatigue, unspecified, which includes chronic fatigue syndrome NOS."<ref name=":2" /> There is however no such code in the ICD,<ref name="ICD10"/> only in the U.S.'s clinical modification, the [[ICD-10-CM]].<ref name="ICD-10-CM">{{citation |url=https://icd10cmtool.cdc.gov/?fy=FY2022&query=fatigue |website=National Center for Health Statistics| title = R53 Malaise and fatigue {{!}} General symptoms and signs (R50-R69) {{!}} ICD-10-CM Index and Tabular | date = 2007 | access-date=2022-09-21}}</ref><ref name=":30">{{Cite web|url=https://www.twitlonger.com/show/n_1sqvhh3| title = TwitLonger — When you talk too much for Twitter|website=twitlonger.com|language=en|access-date=2019-08-19}}</ref> White has also written that "Fink's concept of body distress syndrome" was recently incorporated into [[ICD-11]]<ref name=":2" />, which is incorrect. For the core ICD-11, WHO has approved the differently conceptualized, "Bodily distress disorder (BDD) which is distinct from Fink's concept of Bodily Distress Syndrome.<ref name=":30" />{{citation needed}} In a lecture for the re-insurance company Swiss RE, White emphasized that a diagnosis of CFS makes it easier than a diagnosis of ME to use a mental health exclusion in insurance policies.<ref name="peter-white-and-swiss-re">{{Cite web|url=http://www.virology.ws/2017/08/07/trial-by-error-retired-pace-investigator-peter-white-and-swiss-re/| title = Trial by Error: Retired PACE Investigator Peter White and Swiss Re|website=[[Virology blog]]|access-date=2019-08-19}}</ref> He argued that “a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10.”<ref>{{Cite web|url=http://www.freezepage.com/1374761286EFCHIYENBE| title = FreezePage|website=freezepage.com|access-date=2019-08-19}}</ref> === Conflict of interests === ====Disability benefits work==== Peter White has performed paid and unpaid work for the United Kingdom's [[Department for Work and Pensions]] (DWP)<ref name=":19" /><ref>Williams M. [http://www.investinme.org/Article405%20DWP%20&%20PACE.htm The involvement of the PACE Trial Principal Investigators and the Director of the Clinical Trials Unit with the Department for Work and Pensions.] March 2011.</ref>, which is the government department responsible for administering and reforming the assessment of sickness and disability payments, including the controversial Employment Support Allowance (ESA)<ref>{{Cite news | url=https://www.bbc.com/news/uk-37899305| title = UK accused of disability rights violations | last = BBC news | first = | date = 2016-11-07|work=|access-date=2019-08-22|archive-url=|archive-date=|language=en-GB|quote= | author-link = BBC}}</ref> and Personal Independence Payments (PIP)<ref name="Briefing2019">{{Citation | last = Clark | first = Adam | author-link = | last2 = Bellis | first2 = Alexander | authorlink2 = | last3 = O'Donnell | first3 = Michael | author-link3 = | last4 = Jap | first4 = Bess | author-link4 = | last5 = McInnes | first5 = Roderick | authorlink5 = | last6 = Mackley | first6 = Andrew | authorlink6 = | last7 = Kennedy | first7 = Steven | last8 = | first8 = | date = 2019-04-18| title = Ten years of the work capability assessment in relation to employment support allowance and universal credit {{!}} Debate pack | url =https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CDP-2019-0092 | website = House of Commons Library {{!}} Parliament UK|access-date=Sep 14, 2022|quote=|via=}}</ref> for people of working age. White helped draft the DWP's initial ''disability assessment guidelines for CFS'' from 2005 - 2007, which were rejected by all UK ME charities as "unfit for purpose".<ref>{{Cite web|url=https://www.meassociation.org.uk/2007/07/mea-responds-to-version-10-of-the-dwp-medical-guidance/| title = MEA responds to Version 10 of the DWP medical guidance | last = ME Association | first = | authorlink = ME Association | date = Jul 2007 | website = |language=en-GB|archive-url=|archive-date=|access-date=2019-08-23|quote="For the past two years we have been in negotiation with the Department of Work and Pensions (DWP) in order to try produce new medical guidance that will be free from psychiatric bias and will properly reflect the spectrum of ill health and disability that is experienced by people with moderate or severe ME/CFS"}}</ref><ref name="ParliamentUnum" /> In 2017, the United Nations released a report that was highly critical of the benefits, and of the UK treatment of disabled people.<ref name="Briefing2019" /><ref>{{Cite web|url=https://www.huffingtonpost.co.uk/amp/entry/dwp-overhaul-of-disability-assessments_uk_5c8a3113e4b038892f4aa755/| title = Ministers Plan Multi-Billion Pound Overhaul of 'Demeaning' Disability Benefit Assessments {{!}} HuffPost UK|website=huffingtonpost.co.uk|access-date=2019-08-22}}</ref> White is member of the Independent Medical Experts Group, which advises the UK's Ministry of Defence regarding its Armed Forces Compensation Scheme and provides paid consultancy to re‐insurance companies.<ref name=":2" /> White did not disclose his financial conflicts of interest to the participants of the PACE Trial, of which he was the lead investigator. According to Journalist David Tuller, The PACE authors “promised in their protocol to adhere to this foundational human rights document, among other ethical codes. Despite this promise, they did not tell prospective participants about their financial and consulting links with insurance companies, including those in the disability sector. That ethical breach raises serious concerns about whether the “informed consent” they obtained from all 641 of their trial participants was truly ‘informed,’ and therefore legitimate.”<ref>{{Cite web|url=http://www.virology.ws/2017/08/07/trial-by-error-retired-pace-investigator-peter-white-and-swiss-re/| title = Trial by Error: Retired PACE Investigator Peter White and Swiss Re|website=[[Virology blog]]|access-date=2019-08-19}}</ref> ====Health insurance and reinsurance industry links ==== Peter White provides paid consultancy to re‐insurance companies,<ref name=":19" /> including both UnumProvident<ref name="ParliamentUnum">{{Cite web|url=https://publications.parliament.uk/pa/cm200607/cmselect/cmhealth/503/503we79.htm| title = House of Commons - Health - Written Evidence | last = Hooper | first = Malcolm | authorlink=Malcolm Hooper | date = 2007 | website = publications.parliament.uk|at=Para 12|archive-url=|archive-date=|access-date=2019-08-23}}</ref> and Re-Swiss.<ref name="ReSwissMalingering">{{Cite web|url=https://twitter.com/johnthejack/status/1052919934697783296?s=20| title = Attendance at Oxford meeting funded by insurance company. Can upload PACE trial COIs, should you wish which were made before publication of paper but not prior to trial. One Health by TC and PW. Briefing to Swiss Re by PW.pic.twitter.com/LsKkQnMx0E | last = Peters | first = John | date = 2018-10-18 | website = @johnthejack|language=en|access-date=2019-08-23}}</ref><ref name="peter-white-and-swiss-re" /><ref name="Tuller20151117" /> <ref name="SwissRe2011" /> ==== Directorships and Shareholdings ==== Peter White was a director of OneHealth (Company number 04364122) from 2002 to 2010.<ref>{{Cite web|url=https://www.companieslondon.com/uk/04364122/one-health| title = One Health | last = London | first = Companies|website=Companies London|language=en|access-date=2019-08-19}}</ref> The memorandum of association states that the purpose is to promote the biopsychosocial model of illness.<ref>{{Cite web|url=http://companycheck.co.uk/company/04364122/ONE-HEALTH/companies-house-data | title = ONE HEALTH. Free business summary taken from official companies house information. Free alerts. Registered as 04364122 | last = ltd | first = company check|website=Company Check|language=en|access-date=2019-08-19}}</ref> From 1999 to the present, White has been a director of Added Value Advisory Services (Company number 03764154), a company that focuses on “management consultancy activities other than financial management.”<ref>{{Cite web|url=https://beta.companieshouse.gov.uk/company/03764154| title = ADDED VALUE ADVISORY SERVICES LIMITED - Overview (free company information from Companies House)|website=beta.companieshouse.gov.uk|language=en|access-date=2019-08-19}}</ref> Since November 2018 White is also director of PDW Medical Limited, a company that focuses on specialists medical practice activities.<ref>{{Cite web|url=https://beta.companieshouse.gov.uk/company/11702078| title = PDW MEDICAL LIMITED - Overview (free company information from Companies House)|website=beta.companieshouse.gov.uk|language=en|access-date=2019-08-19}}</ref><ref name="Williams2016PW" /> ==Notable studies and articles related to ME/CFS== {{See also |PACE trial documents}} *2003, Identification of ambiguities in the [[Fukuda criteria|1994 chronic fatigue syndrome research case definition]] and recommendations for resolution<ref name="Reeves,2003">{{Citation | last1 = Reeves | first1 = W.C. | authorlink = William Reeves | last2 = Lloyd | first2 = A. | authorlink2 = Andrew Lloyd | last3 = Vernon | first3 = S.D. | authorlink3 = Suzanne Vernon | last4 = Klimas | first4 = N. | authorlink4 = Nancy Klimas | last5 = Jason | first5 = L.A. | authorlink5 = Leonard Jason | last6 = Bleijenberg | first6 = G. | authorlink6 = Gijs Bleijenberg | last7 = Evengard | first7 = B. | authorlink7 = Birgitta Evengård | last8 = White | first8 = P.D. | authorlink8 = Peter White | last9 = Nisenbaum | first9 = R. | author-link9 = Rosane Nisenbaum | last10 = Unger | first10 = E. | authorlink10=Elizabeth Unger| title = Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution|journal=BMC Health Services Research|volume=3|issue=25 | date = 2003 | doi=10.1186/1472-6963-3-25}}</ref> - [https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-3-25 (Full Text)] *2004, Immunological Changes After Both Exercise and Activity in Chronic Fatigue Syndrome: A Pilot Study<ref>P. D. White, K. E. Nye, A. J. Pinching, T. M. Yap, N. Power, V. Vleck, D.J. Bentley, J. M. Thomas, M. Buckland & J. M. Parkin. (2004). Immunological Changes After Both Exercise and Activity in Chronic Fatigue Syndrome: A Pilot Study. ''Journal of Chronic Fatigue Syndrome'', Vol. 12, Iss. 2, pp. 51-66. http://dx.doi.org/10.1300/J092v12n02_06</ref> *2012, Alternative Diagnoses to Chronic Fatigue Syndrome in Referrals to a Specialist Service: Service Evaluation Survey<ref name="Devasahayam2012">{{Cite journal | last = Devasahayam | first = Anoop | author-link = | last2 = Lawn | first2 = Tara | authorlink2 = | last3 = Murphy | first3 = Maurice | author-link3 = | last4 = White | first4 = Peter D | authorlink4 = | date = Jan 2012| title = Alternative Diagnoses to Chronic Fatigue Syndrome in Referrals to a Specialist Service: Service Evaluation Survey|url=https://journals.sagepub.com/doi/epub/10.1258/shorts.2011.011127|journal=JRSM Short Reports|volume=3|issue=1|pages=1–5|doi=10.1258/shorts.2011.011127|issn=2042-5333|pmc=PMC3269106|pmid=22299071|access-date=|quote=|via=}}</ref> [https://journals.sagepub.com/doi/epub/10.1258/shorts.2011.011127 (Full text)] ::Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses.<ref name="Devasahayam2012" /> *2013: [https://www.cambridge.org/core/journals/bjpsych-bulletin/article/planning-implementation-and-publication-of-a-complex-intervention-trial-for-chronic-fatigue-syndrome-the-pace-trial/539F6F7132848EE05207A4E271813C9A/core-reader The planning, implementation and publication of a complex intervention trial for chronic fatigue syndrome: the PACE trial]<ref name="PACEplanning2013">{{Cite journal | last = Sharpe | first = Michael | authorlink = Michael Sharpe | last2 = Chalder | first2 = Trudie | author-link2 = Trudie Chalder | last3 = White | first3 = Peter D. | authorlink3 = Peter Whitedate=Feb 2015 | title = The planning, implementation and publication of a complex intervention trial for chronic fatigue syndrome: the PACE trial|url=https://www.cambridge.org/core/journals/bjpsych-bulletin/article/planning-implementation-and-publication-of-a-complex-intervention-trial-for-chronic-fatigue-syndrome-the-pace-trial/539F6F7132848EE05207A4E271813C9A/core-reader|journal=BJPsych Bulletin|language=en|volume=39|issue=1|pages=24–27|doi=10.1192/pb.bp.113.045005|issn=2056-4694|quote=|via=}}</ref> *2016, [https://www.ncbi.nlm.nih.gov/pubmed/27411750 Complementary and alternative healthcare use by participants in the PACE trial of treatments for chronic fatigue syndrome] *2016, [https://www.ncbi.nlm.nih.gov/pubmed/27521650 A UK based review of recommendations regarding the management of chronic fatigue syndrome] *2017, Response to: "Do more people recover from chronic fatigue syndrome with cognitive behaviour therapy or graded exercise therapy than with other treatments?"<ref>{{Cite journal | last = Sharpe | first = M. | authorlink = Michael Sharpe | last2 = Chalder | first2 = Trudie | author-link2 = Trudie Chalder | last3 = Johnson | first3 = A.L. | author-link3 = | last4 = Goldsmith | first4 = K.A. | authorlink4 = Kimberley Goldsmith | last5 = White | first5 = P. D. | authorlink5 = Peter White | date = Feb 2017| title = Do more people recover from chronic fatigue syndrome with cognitive behaviour therapy or graded exercise therapy than with other treatments? | url = |journal = Fatigue: Biomedicine, Health & Behavior |volume=5|issue=1 | pages = 57-61|doi=10.1080/21641846.2017.1288629|quote=|via=}}</ref> [http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1288629 (Abstract)] *2017, Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001–2013: a Clinical Practice Research Datalink study<ref>Collin, Simon M, Bakken, Inger J, Nazareth, Irwin, Crawley, Esther and White, Peter D, 2017, 'Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001–2013: a Clinical Practice Research Datalink study'. J R Soc Med, 110(6): 231–244. DOI: 10.1177/0141076817702530</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499564/ (Full Text)] *2018, The International Collaborative on [[Fatigue]] Following [[Infection]] (COFFI)<ref>{{Cite journal | last = Katz | first = Ben Z | author-link = Ben Katz | last2 = Collin | first2 = Simon M | authorlink2 = Simon Collin | last3 = Murphy | first3 = Gabrielle | author-link3 = Gabrielle Murphy | last4 = Moss-Morris | first4 = Rona | author-link4 = Rona Moss-Morris | last5 = Wyller | first5 = Vegard Bruun | author-link5 = Vegard Bruun Wyller | last6 = Wensaas | first6 = Knut-Arne | authorlink6 = Knut-Arne Wensaas | last7 = Hautvast | first7 = Jeannine L.A. | authorlink7 = Jeannine Hautvast | last8 = Bleeker-Rovers | first8 = Chantal P | authorlink8 = Chantal Bleeker-Rovers | last9 = Vollmer-Conna | first9 = Uté | authorlink9 = Uté Vollmer-Conna | last10 = Buchwald | first10 = Dedra | authorlink10=Dedra Buchwald | last11 = Taylor | first11 = Renée | authorlink11=Renée Taylor | last12 = Little | first12 = Paul | authorlink12=Paul Little | last13 = Crawley | first13 = Esther | authorlink13 = Esther Crawley | last14 = White | first14 = Peter D | authorlink14=Peter White | last15 = Lloyd | first15 = Andrew | authorlink15=Andrew Lloyd | date = 2018-04-03| title = The international collaborative on fatigue following infection (COFFI)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2018.1426086|journal = Fatigue: Biomedicine, Health & Behavior |language=en|volume=6|issue=2|pages=106–121|doi=10.1080/21641846.2018.1426086|issn=2164-1846|pmc=|pmid=30666281|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333416/ (Full text)] *2020, Sick of the sick role: Narratives of what 'recovery' means to People with CFS/ME<ref>{{Cite journal | last = Cheshire | first = Anna | last2 = Ridge | first2 = Damien | last3 = Clark | first3 = Lucy V. | last4 = White | first4 = Peter D. | date = 2020-11-11| title = Sick of the Sick Role: Narratives of What “Recovery” Means to People With CFS/ME|url=http://journals.sagepub.com/doi/10.1177/1049732320969395|journal=Qualitative Health Research|language=en|pages=104973232096939|doi=10.1177/1049732320969395|issn=1049-7323}}</ref> [https://journals.sagepub.com/doi/10.1177/1049732320969395 (Full text)] ==Talks and interviews== *[http://www.meactionuk.org.uk/Bergen-What-is-CFS-2009.pdf What is CFS, and what is ME? Bergen, October 20 2009] *[http://www.meactionuk.org.uk/Bergen-Causes-of-CFS-2009-v2.pdf What causes CFS/ME, and does this determine treatment? Bergen, October 20 2009] *[http://www.meactionuk.org.uk/Bergen-Treatment-2009.pdf Treatments for chronic fatigue syndrome. Bergen, 20 October 2009] *[https://www.youtube.com/watch?v=JWsFvmuJxMA&feature=youtu.be&app=desktop Royal Society of Medicine, 28 April 2008] ([https://dxrevisionwatch.files.wordpress.com/2015/11/rsmpeterwhitetranscript5.pdf Transcript]) *[http://www.bbc.co.uk/radio4/youandyours/transcripts_2007_45_mon_03.shtml BBC You & Yours transcript, 5 November 2007] ==Books== *2005, [https://books.google.co.uk/books?id=chwtWAt76JoC&printsec=frontcover&source=gbs_atb#v=onepage&q&f=false Biopsychosocial medicine - An integrated approach to understanding illness] ==Online presence/List of Publications== *[http://www.ncbi.nlm.nih.gov/pubmed/?term=White%20PD%5BAuthor%5D&cauthor=true&cauthor_uid=26618291 PubMed - Peter D White] * [http://www.researchpublications.qmul.ac.uk/publications/staff/19669.html Publications Peter White] ==Learn more== *2015, [http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10052432&fileId=S0033291715002366 Institute of Medicine report - Review] (8 December 2015, see also [[Institute of Medicine report]]) *2016, [http://www.margaretwilliams.me/2016/proof-positive-revisited.pdf 'Proof Positive (Revisited)'] (14 Sep 2016) *2016, [http://www.theguardian.com/society/2016/feb/15/it-was-like-being-buried-alive-victim-of-chronic-fatigue-syndrome?CMP=share_btn_tw ‘It was like being buried alive’: battle to recover from chronic fatigue syndrome] ==See also== * [[Intimidation of PACE critics]] *[[PACE trial]] *[[Wessely school]] *[[Trudie Chalder]] *[[Esther Crawley]] *[[Michael Sharpe]] *[[Simon Wessely]] ==References== <references> <ref name="SwissRe2011">{{citation | last1 = White | first1 = Peter D | authorlink1 = Peter White | title = Managing claims for chronic fatigue the active way | journal = Swiss Re (insurance) | date = 2011 | url = http://www.swissre.com/clients/newsletters/Managing_claims_for_chronic_fatigue_the_active_way.html | archive-url = https://pbs.twimg.com/media/CYt8snwWcAApi_1.png:large | archive-date = 25 Jul 2013 }}</ref> <ref name="Tuller20151117">{{citation | last1 = Tuller | first1 = David | authorlink1 = David Tuller | title = Trial By Error, Continued: PACE Team’s Work for Insurance Companies Is “Not Related” to PACE. Really? | website = [[Virology blog]]| date = Nov 17, 2015 | url = http://www.virology.ws/2015/11/17/trial-by-error-continued-pace-teams-work-for-insurance-companies-not-related-to-pace-really/ }}</ref> <ref name="Williams2016PW">{{citation | last1 = Williams | first1 = Margaret | author-link1 = Margaret Williams | title = Proof Positive (revisited) | date = 14 Sep 2016 | url = http://www.margaretwilliams.me/2016/proof-positive-revisited.pdf }}</ref> </references> [[Category:PACE trial proponents]] [[Category:Psychological paradigm proponents]]
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